Essential Information for Albertans from Alberta Health and Wellness

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Alberta Health Care Insurance Plan
The Alberta Health Care Insurance Plan provides eligible residents of Alberta and their dependants with: • coverage for medically required services provided by physicians; • coverage for medically required oral and maxillofacial surgery and medically required dental services;

• coverage for medically required stays and services in Alberta hospitals; and • some coverage for services provided by optometrists, chiropractors and podiatrists (services must be provided in Alberta). The Schedule of Benefits, which list services and rates paid for these services, are available on the Alberta Health and Wellness website at www.health.alberta.ca.

Alberta Personal Health Card
Please protect this card.
Personal Health Number 12345-0000 Jane Lisa Doe
Gender

S
Year

p am
Mo Day

le

F

Birthdate

1960/11/16

You are eligible for health insurance coverage provided you are a resident of Alberta.

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Table of Contents
Eligibility Registration Changes to Coverage Benefits Exclusions Programs and Benefits for Seniors Supplementary Coverage (Alberta Blue Cross) Travel and Temporary Absence Moving Other Health Care Services Contact Alberta Health and Wellness 4-5 6 7-8 9-12 13-14 15 16-18 19-23 24-25 26-27 back cover

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For the purpose of Alberta Health Care Insurance Plan coverage. • any other person deemed by the regulations to be a resident but not including a tourist. • committed to being physically present in Alberta for at least 183 days in a 12-month period. but their dependants who reside in Alberta are.Eligibility All permanent residents of Alberta must register themselves and their dependants (if applicable) with the Alberta Health Care Insurance Plan. a dependant is defined as: • a spouse (married couples that reside together must register together. (Note: Alberta Health and Wellness considers temporary absences as periods of physical presence). 4 . territory or country. the Royal Canadian Mounted Police. transient or visitor to Alberta. An Alberta resident is defined as a person who is: • legally entitled to be or to remain in Canada and makes his/her permanent home in Alberta. and federal penitentiary inmates are not eligible for coverage. Members of the Canadian Armed Forces. • not claiming residency or obtaining benefits under a claim of residency in another province.

divorced couples must register separately). generally with the parent the child resides with the most. • an adult interdependent partner* (may register together or separately) • a single child and/or an adopted child. 5 5 . and • a single child under 25 years of age and enrolled in three or more courses at an accredited educational institute. if an income tax deduction was claimed. *An adult interdependent partner is a person who lives with another person in a relationship of interdependence: • for a continuous period of not less than three years. under 21 years of age and wholly dependent on his/her parent(s).ab. the custodial parent should register the child. • a single child 21 years of age or older and wholly dependent on the parent(s) because of a physical or mental disability. In cases of separation or divorce. Proof of enrolment may be required. if as a result of the relationship the partners have a child by birth or adoption.qp. In cases of joint custody.ca.gov. the child is registered on the account agreed to by both parents. • a foster child and/or ward of the court. separated couples may register together or separately. The Adult Interdependent Relationships Act may be viewed at www. or • if the partners have entered into an adult interdependent partner agreement as provided for in the Adult Interdependent Relationships Act. or • of some permanence.

Registration All residents of Alberta must register themselves and their eligible dependants with the Alberta Health Care Insurance Plan. Alberta Health and Wellness sends each person their Alberta Personal Health Card with their personal health number. No one else has the right to use them. Albertans may choose to formally opt out of the Alberta Health Care Insurance Plan. and they are a link to your health information. an Alberta Health and Wellness office. unions. Please contact an Alberta Health and Wellness office for details. however. associations. health. To report cases of suspected misuse of a health care card or number call toll-free: 1-866-278 5104 Please note: You may be asked to show picture identification as well as your personal health card when you obtain health services. 6 . Following registration. New and returning residents are required to provide documents that prove their identity.ca. or from the Alberta Health and Wellness website at www. legal entitlement to be in Canada and Alberta residency with their registration forms. Registration forms are available from employers. Registration is required by law.alberta. Your Alberta personal health care number and card are your personal key to publicly-funded health services.

the dependant is deleted the last day of the month in which notification is received. please notify Alberta Health and Wellness of any changes that may affect your coverage.g. the dependant is added the first day of the month following notification. the dependant is added to the account the date of the event. marriage. Otherwise. 7 . Deleting a dependant If Alberta Health and Wellness receives notification within one month of the event (e. adult interdependent partner relationship).) If Alberta Health and Wellness receives notification within one month of the event (e. Otherwise. the dependant is deleted from the account the day before the event.Changes to Coverage To ensure that registration information stays current. Adding a dependant (Refer back to pages 4 and 5 for a list of who qualifies as a dependant. divorce. child leaves home).g. This includes adding or removing a dependant from your account and changes of name or address.

associations or unions.health. please contact an Alberta Health and Wellness office. Changes can also be made at any Alberta Registry Agent or from the Alberta Health and Wellness website at www. or if the information on the card is not correct or complete. coverage can still be effective the date of birth if notification is received within three months from the date of birth. 8 .ca. Otherwise.alberta.Newborn baby Most babies born in Alberta hospitals are registered by the hospital and coverage is effective the date of birth. If the hospital did not register the baby. If the baby’s Alberta Personal Health Card is not received within a month of registration. or an Alberta Health and Wellness office. Changes can be made by filling out a Notice of Change form available from employers. Name and address changes It is important to notify Alberta Health and Wellness of changes as soon as possible. the effective date is determined at the time of notification.

ca. Tooth related treatments are 9 . which are available on the Alberta Health and Wellness website at www. These benefits may be paid directly by the Alberta Health Care Insurance Plan or they may be provided by a health region or the Alberta Cancer Board. joint and jaw surgery and bone grafts. Physician services The Alberta Health Care Insurance Plan provides full coverage for medically required services provided by physicians. with the exception of private facility fees. this information is in the Schedule of Medical Benefits.alberta. Examples of insured services include cyst removal. Benefits for health services covered directly by the Alberta Health Care Insurance Plan are payable whether they are obtained within Alberta or elsewhere in Canada. Physicians are in the best position to advise which health care services are covered. The Alberta Health Care Insurance Plan pays medical benefits according to the rates established by other provincial/territorial health plans. Oral and maxillofacial surgery and dental services Some specific dental/oral and maxillofacial surgery services performed by a dentist are fully covered.health. Alternatively.Benefits Albertans who are registered with the Alberta Health Care Insurance Plan are entitled to a number of health care benefits.

Chiropractic services Benefits for chiropractic visits and x-rays are payable at specific rates per service to a maximum of $200 per person in a benefit year if the services are provided in Alberta. Podiatry services (foot care) Benefits for some services provided by a podiatrist are payable at specific rates per service to a maximum of $250 per person in a benefit year if the services are provided in Alberta. 10 . The patient or their secondary insurer is responsible for paying these additional costs. Dentists cannot charge their patients for insured services covered by the Alberta Health Care Insurance Plan.. However. Ask your chiropractor for more details.Benefits Continued . The patient or their secondary insurer is responsible for paying these additional costs. Chiropractors can charge more than what the Alberta Health Care Insurance Plan pays. not an insured service. Ask your dentist for more details. Ask your podiatrist for more details. dentists can charge for uninsured services (such as x-rays) they perform in association with an insured service. Podiatrists can charge more than what the Alberta Health Care Insurance Plan pays..

Insured hospital services include: • medically required diagnostic.Optometric services (vision) Benefits are payable if the services are received in Alberta. clinical laboratory and nursing services. and • accommodation at a standard ward rate (semi-private or private accommodation and some other services are not covered). There are additional benefits for some conditions. private/semi private room). There is no additional charge to Albertans for insured hospital services.g. However. 11 . Hospital services Alberta Health and Wellness provides funding to health regions for medically required inpatient and outpatient hospital services. Optometrists cannot charge their patients for services covered by the Alberta Health Care Insurance Plan. Ask your optometrist for more details. • medications given to hospital inpatients (patients may have to pay for prescription medications provided in hospital outpatient departments). a hospital can charge for noninsured services (e. Benefits are limited to one complete exam. one partial exam and one diagnostic procedure per benefit year for children under 19 years of age and seniors 65 years of age and over.

Services covered by the Alberta Health Care Insurance Plan and the amounts paid for health services are subject to change. plus the current year to date by calling the Alberta Health and Wellness automated request system at 780-427-0845 within Edmonton. A statement can be obtained free of charge for the most recent complete benefit period (July 1 to June 30). Statement of Benefits Paid is a list of practitioner services a person received during a specified period. Statements can also be requested for up to seven benefit years at a charge of $63. 12 . or contact an Alberta Health and Wellness office about coverage for a treatment before proceeding. refer to the Alberta Health and Wellness website at www. Discuss coverage with a doctor or other health care provider. The cost of these services can be obtained from the hospital that provided them.60 per request.ca. then 780-427-0845 when prompted. Please note: The Statement of Benefits Paid does not include hospital services.health.alberta. To call toll-free from within Alberta dial 310-0000. Requests for statements that cover more than the free period must be in writing and accompanied by a cheque or money order.

• research program procedures. 13 . • anesthetic charges for services not covered by the Alberta Health Care Insurance Plan (for dental service exceptions. • routine dental care. • medical-legal services. • eyeglasses.Exclusions Some services are NOT covered by the Alberta Health Care Insurance Plan. • medical advice by telephone (unless otherwise stated in the Schedule of Medical Benefits or Schedule of Oral and Maxillofacial Surgery Benefits). but are not limited to: • cosmetic surgery. • transportation costs (contact your health region). • routine eye exams for residents 19 to 64 years of age. dentures. then 780-427-0731 when prompted to determine if coverage for these services is available through the Alberta Aids to Daily Living program). • experimental procedures. • hearing aids (contact 780-427-0731 in Edmonton or toll-free within Alberta at 310-0000. These include. please contact the dentist performing the services).

5 years of age). • some hospital services. licensed massage therapist.g. insurance or sports purposes.Exclusions Continued. homeopath. midwife. podiatry and optometric services obtained outside Alberta. • immunizations (contact your local health region for exceptions). • services provided by an acupuncturist. then 780-427-0731 when prompted to determine if coverage for these services is available through the Alberta Aids to Daily Living program). for employment. • clinical psychologist services. • third-party medical services (e. • chiropractic services provided under the Diagnostic and Treatment Protocols Regulation for the diagnosis and treatment of minor injuries resulting from motor vehicle accidents.. social worker or nutritionist. • prescription drugs (government sponsored supplementary coverage is available from Alberta Blue Cross – see pages 16 and 18). • chiropractic.. • medical and surgical appliances/supplies (contact 780-427-0731 in Edmonton or toll-free within Alberta at 310-0000. such as a private or semi-private room. and for driver’s licenses for individuals under 74. 14 .

ab. Seniors must provide proof of their age to receive this benefit.ca.seniors. or visit the website at www. A comprehensive list of services for seniors is in the Seniors Programs and Services Information Guide. toll-free for the rest of Alberta at 1-800-642-3853. contact the Seniors Information Line in Edmonton at 780-427-7876. Optical and Dental Assistance for Seniors Programs are available through Seniors and Community Supports. 15 .Programs and Benefits for Seniors Alberta Blue Cross Coverage for Seniors Alberta Health and Wellness provides seniors and the dependants covered on their accounts with Alberta Blue Cross coverage at no cost.gov. toll-free for the rest of Alberta at 1-800-642-3853.ca. or visit the website at www.gov.seniors. This is supplementary coverage for prescription drugs and other services. To obtain a copy. For more information on these two programs.ab. contact the Seniors Information Line in Edmonton at 780-427-7876.

ambulance services.health. home nursing care.alberta. mastectomy prosthesis and hospital accommodation in a private or semiprivate room. Multiple Sclerosis (MS) drug coverage is also available under the Alberta Blue Cross Non-Group plan subject to prior approval from the MS Drug Review Panel.Supplementary Coverage (Alberta Blue Cross) Alberta Health and Wellness funds the following Alberta Blue Cross non-group supplementary health care plans. ca. prosthetic and orthotic benefits. 16 . Coverage is provided for specific drugs used in the treatment of relapsing/remitting MS. This coverage provides the following benefits with some restrictions and/or maximum limits: prescription drugs. Alberta Blue Cross Coverage for Seniors See page 15 for information about this coverage. Alberta Blue Cross Non-Group Coverage Coverage is available to residents under the age of 65 years subject to the payment of premiums. Applications and more information are available by contacting an Alberta Health and Wellness office or from the Alberta Health and Wellness website at www. clinical psychological services.

Applications for this program may be submitted for the current subsidy period.health. which may reduce your non-group Blue Cross Premiums. Eligibility for this program is based on the account holder’s (and. plus two previous periods immediately before the current subsidy period. Applications are available by contacting an Alberta Health and Wellness office or from the Alberta Health and Wellness website at www.alberta. their spouse’s or partner’s) taxable income for the taxation year immediately before the subsidy period (April 1 to March 31). 17 .health. Information and applications are also available from employers. if applicable.alberta.Payment Options Pre-Authorized Payment Plan The Pre-Authorized Payment Plan provides a convenient and reliable way to pay premiums monthly.ca.ca. Premium Subsidy Program Non-senior Albertans with lower incomes are encouraged to apply for the Premium Subsidy Program. Applications and information regarding qualifying taxable income levels are available by contacting an Alberta Health and Wellness office or from the Alberta Health and Wellness website at www.

Private health care insurance Albertans can purchase supplementary health insurance coverage from private insurers to help with costs for services that are only partially covered or not covered by the Alberta Health Care Insurance Plan. Alberta Blue Cross Palliative Care Drug Coverage Alberta Health and Wellness offers premiumfree Alberta Blue Cross coverage for drugs required by residents who are diagnosed as palliative.ca. alberta.. whose physicians or nurse practitioner have applied for the coverage on their behalf.Supplementary Coverage Continued .health. Please note: Claims for any of the government sponsored Alberta Blue Cross Plans must be received by Alberta Blue Cross within 12 months of the service date to be considered for payment. and who are receiving treatment at home. Individuals interested in purchasing additional health insurance coverage should speak with their employer or contact a private insurer directly to determine what coverage is available. Supplementary health insurance coverage cannot be purchased through the Alberta Health Care Insurance Plan. Applications and more information are available by contacting an Alberta Health and Wellness office or from the Alberta Health and Wellness website at www.. 18 .

prior approval must be obtained from Alberta Health and Wellness. eating disorders or other behavior disorders outside Alberta. are required to contact an Alberta Health and Wellness office before leaving to ensure Alberta Health Care Insurance Plan coverage is maintained. in the brochure Travel Health Insurance Matters.ca. it is important to note that the Alberta Health Care Insurance Plan does not cover some health services and there are maximum benefits on some services that are covered.Travel and Temporary Absence When traveling. More information on Alberta Health Care Insurance Plan coverage while traveling outside Alberta is available on the Alberta Health and Wellness website at www. 19 . alberta. To be eligible for treatment of drug and/ or alcohol abuse. Albertans should always carry their Alberta Personal Health Card and show it when they obtain health services. Hospital services must be provided in a general or auxiliary hospital to be eligible for coverage. Residents who will be absent from Alberta for more than six months.health. or by contacting an Alberta Health and Wellness office. When traveling outside Alberta.

This will greatly reduce the risk of any unexpected medical costs for the traveler. See private health insurance section on page 18 for information.. A claim may be submitted for these service expenses to the Alberta Health Care Insurance Plan for reimbursement at Alberta rates. Alberta Health and Wellness recommends that everyone purchase travel health care insurance. To ensure travel insurance is adequate. Travel insurance is recommended to cover costs for ambulance services. Travel outside Canada Costs for health care services obtained outside Canada are high.Travel and Temporary Absence Continued . even for short trips. travelers should consider all pre-existing conditions they may have. Medical claims are paid at the established rates of the province or territory where the services were obtained. Travel health insurance is not available through the Alberta Health Care Insurance Plan. Travel within Canada Claims for medically required physician and hospital services received elsewhere in Canada are usually billed automatically to the Alberta Health Care Insurance Plan (except physician services in Quebec). A patient may be asked to pay directly for oral surgical services received outside Alberta. private and semi-private room accommodations. More information on Alberta Health Care Insurance Plan coverage while traveling outside Alberta is available on the Alberta Health and Wellness website at 20 ..

Hospital benefits are inclusive of x-rays. or • the duration of time the resident is enrolled as a full-time student at an accredited educational institute. or by contacting an Alberta Health and Wellness office. 21 .health. etc. they may apply for the following extensions of coverage: • up to two years (24 months) for travel. business or missionary service. and inpatient hospital benefits are not payable for the day of discharge.ca. in the brochure Travel Health Matters. Temporary absence Residents must maintain their Alberta Health Care Insurance Plan coverage if they temporarily leave Alberta for another part of Canada and intend to return to Alberta within 12 months. The maximum amount paid for inpatient hospital care provided outside Canada is $100 per day (in Canadian funds). A maximum benefit of $50 (in Canadian funds) is payable for one outpatient hospital visit per day. whichever is less. room and board.www. lab tests. Out-of-country practitioner services are payable at the same rate an Alberta practitioner would receive for the same or a similar service. or • up to four years (48 months) for absences due to work. If they leave for a longer period of time. personal visits or educational leave (sabbatical).alberta. or temporarily leave Canada and intend to return to Alberta within six months. or the amount paid. but intend to return to Alberta to live permanently.

Submitting a claim Claims for health services received outside Alberta and paid directly by the individual. Residents normally in Alberta 183 days of the year remain eligible for coverage.Travel and Temporary Absence Continued .. Please note: Separate bills are needed for hospital services and for practitioner services. If they are away longer. This can be done by filling out the Out-of-Province Claim for Physician/ Practitioner Services (AHC0693). they must be translated into English before they are submitted. Claim forms can be submitted by fax to 780-422-1958 or mailed to: Alberta Health and Wellness Out-of-Country/Out-of-Province Claims PO Box 1360.health. If the bills are not in English.alberta. but Alberta is still their permanent place of residence.. Copies of paid bill(s) must be included to be processed. Stn Main Edmonton AB T5J 2N3 22 . must be submitted within 365 days of the service date. ca. This form is available by contacting an Alberta Health and Wellness office or from the Alberta Health and Wellness website at www. they need to contact an Alberta Health and Wellness office to apply for continued coverage.. Temporary absence continued ..

23 .health. For more information on the program visit the Alberta Health and Wellness website at www.Special out-of-country benefit programs The Out-of-Country Health Services Committee may approve additional funding for patients who require medically necessary physician. Applicants require a referral from their physician with appropriate supporting documentation. or toll-free in Alberta at 310-0000 then dial 780-422-0969 when prompted.ca or call 780-422-0969 in Edmonton. oral surgery and hospital services not available in Canada. All insured elective health services require prior approval by the Committee to be eligible for payment.alberta.

Alberta Health and Wellness will determine the date coverage becomes effective. legal entitlement to be in Canada and Alberta residency.Moving Moving to Alberta When moving to Alberta from another province or territory. coverage must be maintained in the province 24 . Registration must occur before the first day of the fourth month after the date of arrival. If the application for registration is late. If an application for registration is late. Alberta Health Care Insurance Plan coverage is effective the first day of the third month following the date of arrival. To determine eligibility requirements for those holding temporary immigration documents. coverage may be effective on the date of arrival if the application for registration is submitted within three months of arrival. Please Note: If a person moves to Alberta prior to their family and the family plans to move to Alberta within 12 months. Coverage cannot be provided until Alberta Health and Wellness receives these documents. Alberta Health and Wellness will determine the date coverage becomes effective. When moving to or returning to Alberta from outside Canada. New and returning residents who are applying for coverage with the Alberta Health Care Insurance Plan are required to provide documents that prove their identity. please contact an Alberta Health and Wellness office.

25 .or territory the family is living in. This ensures continuous health care coverage until coverage in the new province/territory begins. Permanent move When moving from Alberta to another province or territory. Alberta Health Care Insurance Plan coverage should be applied for within three months of the arrival of all family members. If the family will not join the person in Alberta within 12 months. An extra month of coverage for travel time can be requested if required. Alberta Health Care Insurance Plan coverage remains effective for the balance of the month of departure. plus the two months immediately following departure. the person’s coverage is effective the first day of the 13th month following his/her arrival in Alberta. When moving permanently from Alberta to another country. arrangements can be made to extend Alberta Health Care Insurance Plan coverage for up to three months from the date of departure. Moving from Alberta Temporary move See temporary absence section on page 22 and 23 for information. Coverage is effective on the first day of the third month after the family’s arrival.

Physical therapy services received in Alberta may be covered by your health regions’ Community Rehabilitation Program. 26 . nutrition.Other Health Care Services Public health services such as home care. community health nursing and environmental health are available through your health region. Contact your health region for details. community agencies or hospitals and are usually available at no cost. Some charges may apply. There may be an accommodation charge for long-term treatment. early intervention. Please contact your health region for more details. speech-language pathology. immunization. Mental health services provided by psychiatrists and other physicians within Alberta at government-funded mental health clinics. Physical therapy services provided outside Alberta are only payable in a hospital and paid in accordance with the out-patient rate only. Contact your health region for more information.

and eating disorders on page 21.ca or in your local telephone book.Questions about hospital. 27 .alberta. health. Information on how to determine the health region you live in or how to contact your health region. See the sections in this brochure on Travel and Temporary Absence on pages 21 to 25. drug abuse. clinical laboratory or physical therapy benefits should be directed to your health region. Coverage for services provided out-ofprovince/out-of-country are subject to rate maximums. is available on the Alberta Health and Wellness website at www. as well as the prior approval requirements for treatments relating to alcohol abuse.

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T5J 2N3 In person To locate the office nearest you. Station Main Edmonton AB. please telephone our office or visit our website. Inquiries can be made through one of the following methods: Mail Alberta Health and Wellness PO Box 1360. To call toll-free from other areas of Alberta.ca For your protection. dial 1-800-232-7215.health. please quote your Alberta personal health number when making an inquiry.ca E-mail health.Contact Alberta Health and Wellness When applicable.ab. This is not a voice line.ahcipmail@gov. please do not transmit your personal health number or other personal information by e-mail. then dial 780-427-1432 when prompted Deaf/hearing impaired callers with a TDD/TTY In the Edmonton area please call 780-427-9999.alberta. Phone 780-427-1432 in Edmonton Toll-free from other areas of Alberta 310-0000. 32 NCN0009 (2009/04) . Fax 780-422-0102 Edmonton Website www.